Ross Perfetti Angela, Jacoby Sara F, Buddai Sruthi, Kaplan Lewis J, Lane-Fall Meghan
Harvard Medical School, Harvard University, Cambridge, MA.
Department of Anthropology, University of Pennsylvania, Philadelphia, PA.
Crit Care Explor. 2022 May 6;4(5):e0685. doi: 10.1097/CCE.0000000000000685. eCollection 2022 May.
There is little research about how caregiver experiences evolve from ICU admission to patient recovery, especially among caregivers for patients who have traumatic injuries. In this study, we characterize diverse caregiver experiences during and after ICU admission for injury.
This prospective observational study is based in a level 1 trauma center in Philadelphia, Pennsylvania. Longitudinal interviews among caregivers of patients who required ICU admission for traumatic injury were conducted from the time of ICU admission to 12 months after hospital discharge. Transcripts were analyzed using a qualitative descriptive approach.
Sixty-five interviews were conducted with 19 caregivers. The interview results converged on four areas: experiences in the ICU, the aftermath of violent traumatic injury, caregiver responsibilities, and care in the context of the wider family. In the ICU, caregivers contended with worry and uncertainty, and they often hid these feelings. Many felt that they always needed to be at the bedside, leading to stress and exhaustion. Caregivers had difficulty communicating with their loved ones, and communication itself sometimes became a source of conflict. Over time, caregivers were burdened by many managerial responsibilities. In addition, violent traumatic injury caused an overlay of concern for patients' safety. The need to plan for recovery caused caregivers to make substantial sacrifices. As a result of these difficult experiences, some caregivers and patients drew closer together, while others were divided by conflict.
Illness after traumatic injury may be devastating for caregivers, disrupting emotional wellbeing and other aspects of life. Caregivers are variably prepared for the challenges of ICU care and caregiving through convalescence and require robust support during and after ICU admission to enable effective communication, resource access, and an ongoing relationship with the healthcare team.
关于照顾者的经历如何从重症监护病房（ICU）入院到患者康复阶段演变的研究很少，尤其是在创伤性损伤患者的照顾者中。在本研究中，我们描述了创伤性损伤患者在ICU入院期间及之后不同照顾者的经历。
这项前瞻性观察性研究以宾夕法尼亚州费城的一家一级创伤中心为基础。对因创伤性损伤而需要入住ICU的患者的照顾者进行了从ICU入院时到出院后12个月的纵向访谈。使用定性描述方法对访谈记录进行了分析。
对19名照顾者进行了65次访谈。访谈结果集中在四个方面：在ICU的经历、暴力创伤性损伤的后果、照顾者的责任以及在更广泛家庭背景下的护理。在ICU中，照顾者要应对担忧和不确定性，并且他们常常隐藏这些感受。许多人觉得自己总是需要守在床边，这导致了压力和疲惫。照顾者在与亲人沟通方面存在困难，而且沟通本身有时也会成为冲突的根源。随着时间的推移，照顾者承担了许多管理责任。此外，暴力创伤性损伤引发了对患者安全的额外担忧。为康复做准备的需求使照顾者做出了巨大牺牲。由于这些艰难经历，一些照顾者和患者的关系更加亲密，而另一些则因冲突而产生隔阂。
创伤性损伤后的疾病可能对照顾者造成毁灭性影响，扰乱其情绪健康和生活的其他方面。照顾者对ICU护理以及康复期护理的挑战准备程度各不相同，在ICU入院期间及之后需要强有力的支持，以实现有效的沟通、资源获取以及与医疗团队的持续关系。
